title: Bilateral and pseudobilateral tonsilloliths: Three dimensional imaging with cone-beam computed tomography.
abstract: OBJECTIVE
  Tonsilloliths are calcifications found in the crypts of the palatal tonsils and can be detected on routine panoramic examinations. This study was performed to highlight the benefits of cone-beam computed tomography (CBCT) in the diagnosis of tonsilloliths appearing bilaterally on panoramic radiographs.
  
  
  METHODS
  The sample group consisted of 7 patients who had bilateral radiopaque lesions at the area of the ascending ramus on panoramic radiographs. CBCT images for every patient were obtained from both sides of the jaw to determine the exact locations of the lesions and to rule out other calcifications. The calcifications were evaluated on the CBCT images using Ez3D2009 software. Additionally, the obtained images in DICOM format were transferred to ITK SNAP 2.4.0 pc software for semiautomatic segmentation. Segmentation was performed using contrast differences between the soft tissues and calcifications on grayscale images, and the volume in mm(3) of the segmented three dimensional models were obtained.
  
  
  RESULTS
  CBCT scans revealed that what appeared on panoramic radiographs as bilateral images were in fact unilateral lesions in 2 cases. The total volume of the calcifications ranged from 7.92 to 302.5mm(3). The patients with bilaterally multiple and large calcifications were found to be symptomatic.
  
  
  CONCLUSIONS
  The cases provided the evidence that tonsilloliths should be considered in the differential diagnosis of radiopaque masses involving the mandibular ramus, and they highlight the need for a CBCT scan to differentiate pseudo- or ghost images from true bilateral pathologies.
authors.affiliation: Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Kırıkkale University, Kırıkkale, Turkey.
authors.forename: Melda
authors.initials: M
authors.lastname: Mısırlıoglu
authors.forename: Rana
authors.initials: R
authors.lastname: Nalcaci
authors.forename: Mehmet Zahit
authors.initials: MZ
authors.lastname: Adisen
authors.forename: Selmi
authors.initials: S
authors.lastname: Yardımcı
keywords: Cone-Beam Computed Tomography; Panoramic Radiography; Tonsillolith